Distinct and shared contributions of diagnosis and symptom domains to cognitive performance in severe mental illness in the Paisa population: a case-control study.

BACKGROUND: Severe mental illness diagnoses have overlapping symptomatology and shared genetic risk, motivating cross-diagnostic investigations of disease-relevant quantitative measures. We analysed relationships between neurocognitive performance, symptom domains, and diagnoses in a large sample of people with severe mental illness not ascertained for a specific diagnosis (cases), and people without mental illness (controls) from a single, homogeneous population. METHODS: In this case-control study, cases with severe mental illness were ascertained through electronic medical records at Clínica San Juan de Dios de Manizales (Manizales, Caldas, Colombia) and the Hospital Universitario San Vicente Fundación (Medellín, Antioquía, Colombia). Participants were assessed for speed and accuracy using the Penn Computerized Neurocognitive Battery (CNB). Cases had structured interview-based diagnoses of schizophrenia, bipolar 1, bipolar 2, or major depressive disorder. Linear mixed models, using CNB tests as repeated measures, modelled neurocognition as a function of diagnosis, sex, and all interactions. Follow-up analyses in cases included symptom factor scores obtained from exploratory factor analysis of symptom data as main effects. FINDINGS: Between Oct 1, 2017, and Nov 1, 2019, 2406 participants (1689 cases [schizophrenia n=160; bipolar 1 disorder n=519; bipolar 2 disorder n=204; and major depressive disorder n=806] and 717 controls; mean age 39 years (SD 14); and 1533 female) were assessed. Participants with bipolar 1 disorder and schizophrenia had similar impairments in accuracy and speed across cognitive domains. Participants with bipolar 2 disorder and major depressive disorder performed similarly to controls, with subtle deficits in executive and social cognition. A three-factor model (psychosis, mania, and depression) best represented symptom data. Controlling for diagnosis, premorbid IQ, and disease severity, high lifetime psychosis scores were associated with reduced accuracy and speed across cognitive domains, whereas high depression scores were associated with increased social cognition accuracy. INTERPRETATION: Cross-diagnostic investigations showed that neurocognitive function in severe mental illness is characterised by two distinct profiles (bipolar 1 disorder and schizophrenia, and bipolar 2 disorder and major depressive disorder), and is associated with specific symptom domains. These results suggest the utility of this design for elucidating severe mental illness causes and trajectories. FUNDING: US National Institute of Mental Health.

Caracterización sociodemográfica, del desarrollo psicosexual y del delito en hombres condenados por delitos sexuales recluidos en el centro penitenciario de Manizales / Socio-demographic characterization of psychosexual development and crime in men convicted of sexual crimes imprisoned in the Manizales penitentiary center

Introducción: El artículo presenta las características sociodemográficas del desarrollo psico-sexual y del delito sexual en hombres privados de la libertad por delitos sexuales recluidos en una cárcel de Manizales (Colombia) en el 2011. Además, describe las diferencias entre los abusadores de personas menores o iguales a 12 años y abusadores de personas mayores de esa edad. Métodos: Estudio descriptivo, retrospectivo con muestreo aleatorio simple. Se realizó una entrevista semiestructurada en la que se indagaron las características sociodemográficas, el desarrollo psicosexual, las características del delito y la prevalencia de trastornos mentales en una muestra de 80 personas condenadas por delitos sexuales y recluidas en el Establecimiento Penitenciario de Mediana Seguridad de Manizales. Se llevaron a cabo análisis univariado y bivariado, utilizando la prueba χ² y análisis de regresión logística con las variables que mostraron significancia estadística en el análisis bivariado. Resultados: Se encontró que los condenados por delitos sexuales pertenecen a los estratos socioeconómicos bajos, tienen una baja escolaridad y no recibieron educación sexual. Estos hallazgos adquieren más relevancia cuando los delitos son cometidos contra menores o iguales a 12 años de edad. Conclusiones: La falta de educación sexual, la baja escolaridad y el nivel socioeconómico bajo son factores asociados para la presentación de las agresiones sexuales. Es importante que la sociedad (en especial las instituciones responsables de la salud) encuentre otras medidas adicionales a la penalización de estos comportamientos para lograr un mejor control del problema.

This article introduces the socio-demographic characteristics of psychosexual development and sexual crimes in men deprived of liberty for such crimes who are doing time in a Manizales prison (Colombia) in 2011. It also describes the differences between abusers of individuals under 12 years of age or who are 12 years old, and abusers of individuals over that age. Methodology: This is a descriptive, retrospective study performed by simple random sampling. It consisted of semi-structured interviews in which socio-demographic characteristics, psychosexual development, characteristics of crime, and prevalence of mental disorders were analyzed in a sample of 80 inmates convicted of sexual offenses at the Medium-security Pentientiary center in the city of Manizales. Univariate and bivariate analysis were performed using the χ² test and the logistic regression analysis with variables showing statistical significance in the bivariate analysis. Results: It was found that convicted sex offenders belong to lower socioeconomic levels, have low educational levels, and did not receive any sexual education. Such findings become more relevant when the crimes in questions are committed against 12-year-olders or children under this age. Conclusions: The lack of sexual education, low educational levels and lower socioeconomic levels are associated factors in the case of sexual offenses. It is important for society (particularly health-care institutions) to find additional measures for the criminalization of such behaviors in order to achieve a better control of the problem.